Provider Demographics
NPI:1982188629
Name:PALMETTO SPINE AND PAIN LLC
Entity Type:Organization
Organization Name:PALMETTO SPINE AND PAIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:STELLFOX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-429-7690
Mailing Address - Street 1:207 SPOONBILL CT
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-7334
Mailing Address - Country:US
Mailing Address - Phone:803-429-7690
Mailing Address - Fax:
Practice Address - Street 1:207 SPOONBILL CT
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-7334
Practice Address - Country:US
Practice Address - Phone:803-429-7690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1508166356Medicaid